A new device ("G3 - IOR") for external fixation

External fixation is nowadays an essential part of orthopaedic and traumatological surgery, since it offers a method of firm fixation, which can be applied at some distance from the fracture. It is easy to apply and to remove and, most important, there is no direct contact with the fracture site. THe writers present an apparatus of their own design which should eliminate all the disadvantages of the apparatus at present in use, while at the same time being simpler to apply and more effective in action.

Surgical stabilisation of fractures of the thoracic and lumbar spine by Harrington's technique

The authors review twenty-four cases of fracture and fracture dislocation of the thoracic and lumbar spine treated by open reduction and stabilisation with Harrington's rods. In twenty-one cases posterior arthrodesis was also performed. Distraction rods were used in eighteen patients, compression rods in three and both types in three. In twenty-two cases it was possible to carry out a long term review. Stabilisation was achieved in all but one case. There was an average loss of correction of the kyphosis amounting to 10.5 per cent. Marked improvement was noted in nine patients who had incomplete neurological lesions. In thirteen patients with complete neurological lesions, no improvement was noted. In all the cases the treatment made post-operative nursing easier and the patient was more quickly mobilised.

Surgical treatment of poliomyelitic scoliosis

Between 1968 and 1973 forty nine patients suffering from poliomyelitic scoliosis were treated surgically at the Rizzoli Institute. They were due to asymmetrical paralysis and contracture in the muscles of the trunk and limbs. Associated pathological conditions were found, such as pelvic obliquity, and vascular and trophic changes due to ganglionic lesions. The differing incidence and combination of these factors gave rise to various clinical types of spinal deformity. The average severity of curve was 39 degrees, the localisation was predominantly central, the average extent was ten vertebrae, and there was a marked predominance of right convexity (twenty nine out of thirty six). The rate of progression was maximum during puberty and almost negligible after bony maturity. It was greater in males and was unfavourably affected by the severity and asymmetrical distribution of the paralysis, by the early appearance of the disease, by high localisation of the deformity, and by the erect posture in patients who were ambulant. The most frequent visceral complications were in the respiratory system (ten patients with a deficit over 50%), followed by cardiac changes. Surgical treatment was adopted in patients with progressive curves over 60 degrees, because of the inevitable deterioration in their general condition and the tendency of the deformity to become fixed. Pre-operative correction by Halo-traction results (52% correction) than Risser plasters (38%). Posterior arthrodesis by Harrington's method was carried out in all the more recent cases (forty four). Post-operative plaster was maintained for eight months and then replaced by an orthopaedic corset. At bony maturity there was an averaged improvement of 35% in the angle of curvature, and an average improvement of 6% in vital capacity. The best corrections were obtained in patients under fourteen (42%), in dorso-lumbar scoliosis (40%) and in patients with curves above 100 degrees (38%). There was an average increase in height of 9.1 cms and a reduction in the gibbus of 3.4 cms. The complications included one traumatic pneumothorax, eight pseudarthroses, and breakage of the distraction rod in two cases resulting in complete relapse of the deformity. In six cases the upper hooks became loos and there were two cases of postoperative staphylococcal infection. In the distally sited curves our present policy is towards combining posterior arthrodesis with Dwyer's anterior interbody fusion.

Massive homogenous osteo-articular bone grafts. Long term results

The authors present a long term review of thirty cases of massive homogenous bone grafts carried out at the Istituto Ortopedico Rizzoli between 1967 and 1971. Thirty one of these were either complete or partial diaphyseo- articular grafts. The lesions for which the operations were performed were: twelve giant cell tumours; one Ewing's tumour; two reticulosarcomas; eight osteosarcomas; six chondrosarcomas; one loss of bone substance from trauma, one echinococcosis of the femur and one aneurysmal bone cyst. In some of these cases amputation or disarticulation had been advised but refused by the patient. Follow up three and a half to five years after operation showed complete incorporation of the graft in eight cases, partial incorporation in live, and resorption in four. In the remaining fifteen cases the follow up was terminated by early death, recurrences, infection or intolerance with rejection. In conclusion, the authors recommend that massive osteoarticular homogenous grafts should be confined to the substitution of unicondylar lesions as these offer greater contact with the host bone and therefore a greater possibility of incorporation. The same indications exist in cases involving only diaphyseal substitution where osteogenetic invasion of the graft can occur from both ends. In all the other cases, they recommend either resection arthrodesis or prosthetic replacement.